Low Estrogen vs. High Estrogen in Men 

@MrJd5996: Thank you for the feedback! I truly appreciate your noticing. Since publishing our first video in 2015, I have tried my best to keep up with every thread and have always sought to be a source of information. The TRT industry can, at times, be an expanse of misinformation. We seek to partner with educated patients, working on sound foundations and good judgment. Thank you for taking the time to comment! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@hectorcrissien163: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I talk about hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido or the presentation of erectile dysfunction despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low. More common symptoms get mentioned more often, which is why you see a lot of attention paid to gynecomastia and "roid rage." I have not seen headaches reported with a high level of consistency in relation to estradiol issues. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@michaelwops: Unfortunately, you are right. That was a splicing error in the editing process. However, if you fast forward to the 7:00 mark, the discussion on the symptoms of low estrogen (hot flashes, sexual dysfunction, dry joint ache, and osteoporosis) is listed there. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

Thank you!

@@michaelwops you’re welcome!

Agree

@qsdailydose: Unfortunately, I cannot render dosing recommendations without having an established relationship with a patient. I would caution you to look at why your HCT is so high. This can lead to some dangerous adverse events. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@martinmagaard325: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I talk about hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido or the presentation of erectile dysfunction, even despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Unfortunately, this is one time where your low body fat percentage may be working against you. Aromatization occurs most ubiquitously in adipose (fat) tissue. If you are taking anything like DIM that accelerates or propels the degradation/metabolization of estradiol, this could also be a reason. Keeping a balance between T and E2 is important. Consuming good fats, occasionally imbibing in fermented drinks, and an average to the average-plus amount of body fat keep men's estradiol levels normal. For you, this may be the catalyst for T/E2 imbalance. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partners

What other options are there to raise E2 in males on TRT? My total T 1168ng/dL, E2 26.8pg/mL, shbg 44 nmol/L. Free T 21.6ng/dL Not on any other medication. 175mg cypionate split eod. 92kg 176cm 15%bf 42yo Change to twice a week protocol with a small dose increase? Thanks for the vid

@THERHINOFORZA4: Yes, there are many ways to boost testosterone production naturally. Please look at our blog (tctmed.com/exercise-and-testosterone/) for various options. A balanced diet high in protein and good fats, plentiful, regular, and restorative sleep, avoiding toxins, proper supplementation (zinc, magnesium, vitamin D), and vigorous exercise (HIIT) all contribute to production. To aid the metabolism of estradiol, you can look at adding DIM+CDG. I like the formulation from Jarrow Labs. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

​@@TCTmed i have another question is it possible to stop gyno from getting larger im 16 and its really killing my confidence

@@THERHINOFORZA4 Controlling the hormonal influences and potential imbalances is key. However, it's not just a testosterone/estrogen thing. Other factors like prolactin and body composition can influence gynecomastia. For that, I would recommend seeing a specialist. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@pressf4896: Based on the number (and assuming the unit of measure), it looks like they have reported a "direct" or "analog" free testosterone assay. Before you adjust your regimen, I would recommend you look at your calculated free testosterone. Check out www.issam.ch/freetesto.htm. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@roblincoln10: Unfortunately, the role of SHBG in androgen regulation is much more complex than once thought. Take a look at this excerpt: "In this study we have demonstrated that in the absence of SHBG large amounts of Te rapidly enter the cell where they are inactivated by conjugation to glucuronic acid and effluxed." When symptoms and lab results disagree, it is important to remember that labs only give us insight into serum levels when it's the intracellular environment that we should be most concerned with. You may need to rely on the "tincture of time" to allow things to balance and resolve. I estimate your calculated free testosterone to be ~26 ng/dL. Alone, that number looks pretty good, but chronically low SHBG levels could leave you open to rapid metabolism of free T and thereby actually exacerbate Low T symptoms. Li H, Pham T, McWhinney BC, Ungerer JP, Pretorius CJ, Richard DJ, Mortimer RH, d'Emden MC, Richard K. Sex Hormone Binding Globulin Modifies Testosterone Action and Metabolism in Prostate Cancer Cells. Int J Endocrinol. 2016;2016:6437585. doi: 10.1155/2016/6437585. Epub 2016 Nov 20. PMID: 27990161; PMCID: PMC5136390. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thank you a Augie!! Would that rapid metabolism of T also be applied to my e2? This has been a massive rollercoaster ride. I messed up with the anavar and wished I would've kept that out of the picture for a while. It could have been another story, one more positive.

@@roblincoln10 It certainly could. Free estradiol doesn't get as much press as free testosterone, but the free hormone theory remains pertinent.

@@TCTmed so those massive swings in the e2 could be suspect as well. I'm 4 days post injection on the 200mg and I feel exponentially better each day. Still unusual anxiety and restlessness but absolutely nothing like the first couple right after shot. Even the DHEA and progesterone is affected by this theory, so it could be multifactorial

@@roblincoln10 Yep, it's ALWAYS multifactorial. Even with our best testing, we are still left to make educated guesses about intra/extracellular dynamics and receptor modulation.

@Tobias Birmingham: It definitely sounds like it's time to check your estradiol levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

What a decent estradiol levels while on trt ???

@gust9464: Thank you for the feedback! Whether a level is too high has more to do with the severity or presence vs. absence of associated symptoms. An estradiol level of 68 is "high" per most reference ranges. Still, such a level might be acceptable if you are tolerating it well and not experiencing related irritability, fluid retention, or breast tenderness/tissue growth. I don't recommend doses publicly, but I will tell you that not everyone on TRT needs anastrozole. As with most medical interventions, I prefer the lowest dose possible to achieve optimal results. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Snap the balance between my Testosterone to E2 ratio is way I'm out. Tired , low libido and mood swings. ... What can raise it ?

@Workout Instrumental: The best way to fix a low estrogen level is to not block its production. People on TRT tend to overuse aromatase inhibitors and SERMs. If your testosterone levels are optimal and you don't overuse AIs and SERMs, your E2 should be good to go! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed what if your not using an ai and it's super low and wont rise , is an estradiol valerate tablet the next step ?

@@lynxeffect84 Without an AI, a persistently low E2 may need an "Ultra-sensitive" estradiol test to be more accurately measured. Ultimately, I suspect your free testosterone level to be deficient. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@augiegalindo my free test is high

@Chee Kiat Teo: It is individualized. If I were to pull 5 random charts from established patients, it would be unlikely that you would see any of the 5 on the exact same dosage. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Zachary Scott: Ultimately, whether you bald or not is up to your genetics. DHT, a metabolite of testosterone is involved, but it doesn't make someone who has no genetic predisposition to balding, bald. However, if low testosterone levels are keeping a genetic inevitability at bay, then correcting may accelerate the loss. You can find more comprehensive answers here: tctmed.com/genetics-of-male-pattern-baldness/ Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

That makes sense ! Thank you so much for your response

@@zacharyscott1264 Of course!

@Luis-gn7li: Unfortunately, I have never encountered that type of reaction with any of our patients taking testosterone. You could have a drug sensitivity or an allergy to some component of your injection, but based on my almost 12 years in this space, I would have to say that the symptoms you experienced are rare with TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@mkultra9361: You are most welcome! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@tylerbond5024: You are correct. Typically, optimizing your testosterone levels will help balance your estradiol levels as well. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Itspep1: Yes, I do my best to respond to all comments! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Doc Walrus, hold the pickles: There can be several things affecting your estrogen levels. You may benefit from looking at your calculated free testosterone instead of just your total. Even an above-normal total could yield a below normal free, and less free testosterone means that there will be less aromatization. An ultrasensitive estradiol test can be ordered to get an accurate read on estradiol levels. There is an outside chance that aromatase deficiency could be present. This is a rare condition but can explain low estradiol levels in the face of high testosterone levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed Thank you so so much. I'll certainly ask if my free testosterone is still low, even having high levels in total. I didn't know about that distinction. He has mentioned a possible aromatase deficiency, or even a broader endocrine disorder starting with the pituitary or hypothalamus: I have abnormally high and low levels of several other hormones and neurotransmitters as well.

@@mnbgt101: You're most welcome! I hope you find some definitive answers! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Did you solve your low estrogen?

@OSAMA: If low testosterone is the cause, then a balanced TRT regimen is the best way to treat. We do not use Clomid, and aromatase inhibitors are usually overdone. Your care needs to be directed by someone who has experiencing at managing therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed i used them because of POST CYCLE THERAPY , I was on steroids

@siuuuuuuuuuu813: This method can work for some individuals who aren't predisposed to a high degree of aromatization, but for "high converters," the increased potency of pharmaceutical intervention may be necessary. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed god bless you❤️❤️❤️

@TheShadeOfTea: You could have normal total testosterone and still have below-normal free testosterone. This would leave less testosterone available for aromatization. Testosterone is aromatized in many different tissues, but primarily in adipose (fat) tissue. If you have a low body fat percentage, you would be prone to aromatizing less. Your diet, activity level, and chemical/environmental exposures may have an impact as well. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed I agree , what would the treatment be like if my normal testosterone is fine but free test is low ?

@@theshadeofjett Treatment is managed the same way. We focus primarily on calculated free testosterone level optimization.

@Tim Miller: By the third month in, my patients have usually had 1 or 2 retests to assess biochemical response alongside the development of symptomatic improvement. Estradiol changes, if left unmitigated, are often the cause of a dampening of positive response to TRT. If you haven't sat down with your provider to review your change in symptoms and up to date lab results, that's the place to start. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@dennisdavis2103: Hello, Dennis! DIM as a standalone for treating estradiol elevations may not be enough in some cases, but not everyone on TRT needs "estrogen blockers" (aromatase inhibitors). Whether you need a medication to manage your symptoms/levels should be determined by studying your response to TRT, surveillance of your symptoms, and monitoring your levels. For a patient who isn't a "high converter," DIM can help metabolize estradiol efficiently. I prefer DIM with CDG, as it helps to preferentially support E2 metabolism into more desirable metabolites. Remember that there are other AIs, so anastrozole isn't your only choice. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

@augiegalindo Calcium D Glucerate combo is a great suggestion👍 Also happy to know there's other E2 blocker meds out there too. Thanks Augie!

@@dennisdavis2103 You're welcome!

@dennisdavis2103 hope ypur doing well man i just want to ask what is DIM actually is?

@Jim Mski: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I also mention hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido and erectile dysfunction, even despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Yeah all of these symptoms plus extreme anxiety is what experienced when I discovered my pill bottle was labeled wrong, I was taking my estrogen blocker daily instead of weekly! Absolute torture!!

@Milo: There are a few things to unpack here. First, estrogen (estradiol - E2) levels can definitely impact fluid management. High E2 levels can lead to bloating and fluid retention. This extra fluid doesn't stay in just the vascular space. It pushes into interstitial spaces and even joint spaces. The resultant joint swelling can be painful. On the flip side, dehydration and a reduction in synovial fluid in the joint space can also cause pain. There are many other factors, of course, like intra-articular joint pressure and the osmotic pressure of the synovial fluid itself. Also, changes in E2 can have an impact on SHBG dysfunction/production. In turn, there is a relationship between SHBG levels and thyroid function. Finally, when your thyroid function is properly maintained, your metabolism is better supported. Depending on your activity level, this can certainly have an impact on your appetite. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

What is your current protocol

@@TCTmed sore joints when estrogen is high ? More fluid into the joints should mean more lubrication surely . That's how bodybuilders / poweifters lift such heavy weights its protects the joints. Surely it must be an androgen/ imbalanced ratio that wud make his joints sore or else just low estrogen

@@lynxeffect84 On the contrary, swollen joints can cause discomfort too. The mechanism is different, but if you sprain a joint and it swells up to twice its normal size, a portion of that swelling is due to fluid trapped inside the joint capsule. In a setting where an encapsulated joint is "over-filled," this creates stiffness and discomfort, not just lubrication. The dry joint ache associated with low E2 levels differs, but both presentations can lead to discomfort. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@augiegalindo isn't spraining or injury total differant tho. There's no injury here . He said high estro from trt. Trt isn't going to produce massive doses of high estro.

@bm2618: Unfortunately, volatile changes in estradiol can have profoundly adverse effects on some people. This is why balance in dosing and monitoring is so critical. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Richard Carrrsco, check out my response to Workout Instrumental. Make sure you stay away from AIs and SERMs unless they are absolutely necessary. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@JB B: Yes, they can. However, their efficacy is far below that of aromatase inhibitors in reducing estradiol levels. So, it just depends on where you feel best, and your personal biochemistry and related tendencies. See the above comment. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@JohnRayez-md7dq: I recommend looking at your estradiol levels to guide you. I can't give treatment recommendations, per se, but there is much more to optimizing TRT than just starting someone at 1 mL. If your provider isn't looking deeper, it may be time to find a different provider. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@burek sa sirom: Typically, low estradiol means your testosterone levels are too low. Low estrogen levels can contribute to difficulty sleeping if you are experiencing symptoms such as hot flashes. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed yeah,i know that testosterone levels should be low.but they arent,they are even closer to upper range.wtf?🤷🤷

@@bureksasirom5651 Look into your calculated free testosterone level. Total serum levels can be very misleading. www.issam.ch/freetesto.htm

@Dennis Davis: Yes, sir! We do for our in-clinic patients. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@petkovalevski2502: This is a daunting question. The best minds in the field point primarily to endocrine system disruptors. Some of these are natural environmental factors, but most are manmade. Unfortunately, even when people do "everything right," Low T is becoming more prevalent. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@PK S: Thank you for the feedback! Check out me earlier videos. I played the guitar intro, lol. let me know if that's any better. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Jutemlop: Yes, chronic hypoestrogenism can lead to bone demineralization or osteoporosis. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Try DIM. Arimidex is far too harsh when you are a natural and only at 49 pg/ml. Wich is a bit high for your total T but its not borderline high either.

@Gabor B: Many things lead to increased estradiol production. While increase body fat doesn't appear to be a factor, it could be due to certain dietary components. Research is split on whether or not plant based estrogens, or phytoestrogens, affect our serum levels. Alcohol consumption also increased aromatization, or conversion of testosterone to estradiol. Some people don't metabolize estradiol well, and this is why many recommend the use of supplements like DIM (diindolylmethane). Keep in mind, there are other hormones to consider. Your prolactin level and other pituitary hormones like LH and FSH should be evaluated. Finally, "normal" total testosterone level and "normal SHBG" doesn't necessarily equate to a normal calculated free testosterone level, which in my opinion, is the most important number to know. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Do you take Tramadol for pain management? I do and researched it...it will raise your estro...so will Metformin in diabetics. Its suppresses test thus increasing estro. thus

@qsdailydose: When I do recommend DIM I typically ask patients to get Jarrow's DIM+CDG product. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Testosterone Centers of Texas idk of its helping me or hurting me I’m having erectile issues idk if I need more free t or less

@@qsdailydose8970 DIM and CDG don't have a direct effect on free T. You likely need a full lab evaluation and history with an experienced provider.

Testosterone Centers of Texas doc my point is idk if I should increase my dose or decrease my dose

@@qsdailydose8970 I do understand, but I cannot give treatment management advice without seeing someone as a patient. It's part of the standards I am held to as a provider.

@JWhyOfficial: Aromatase inhibitors are remarkably potent. Without intentionally getting all "soap-box" on you, making guesses on levels and dosing changes is never a good approach. Your changes would suggest that you did, in fact, bottom out your estradiol, but you need expertise and lab results to direct your care. It can take quite a while to get your estradiol back on track. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

When I crash my estrogen (I'm extremely sensitive to AI's) I just pop a quarter tab of 50mg Dbol per day and within a few days its back up to normal. Normally, I feel better immediately following a dose of dbol. Dbol converts to methylestradiol which is a very powerful form of estrogen. It works for me... Without using this method, it can literally take weeks on just test and absence of AI to start feeling better again.

@Victor Diaz: I would strongly recommend sitting down with a provider who understands the value of the calculated free testosterone level and how it can inform decisions on the numbers side. Don't get me wrong, symptoms and safety matter most, but things like units of measure and global evaluation matter. For TRT purposes, a male almost never needs estrogen supplementation. Now, if your body fat percentage is extremely low, you have next to zero phyto/xenoestrogens in your system, you never consume alcohol, and you aren't affected by the numerous things that can stimulate aromatization, then you might be organically low. My presumption is that your total testosterone is not telling the whole story. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thank you so much

@@cuba1266 You're welcome!

@Jay Abrams: We use hCG only in specific cases. I do not subscribe to the theory that hCG is a necessary component of TRT. Also, I avoid using hCG as monotherapy unless the patient is adamant about that being their only option. In our practice, hCG is used with the lowest effective dosing to combat testicular atrophy or for the promotion of fertility while on therapy. Unless a patient requests it (i.e. is bothered enough by it to ask for treatment), we do not routinely prescribe it for mild atrophy. Furthermore, hCG is soon to become scarce if not entirely unavailable on the compounding market. The FDA has reclassified it as a biologic and has moved to make it illegal to import the raw material used for compounding the product. There are alternatives, but as it stands, hCG is on the way out as a compounded medication. The commercially available products are far more expensive. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Loveng Briian: Hypercholesterolemia is listed as a potential adverse reaction with anastrozole. However, I can't say that I've ever seen a case where this was clearly a problem. That being said, most side effects are dose dependent, and very small doses of anastrozole are typical in TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@B88_f: Unfortunately, you are right. That was a splicing error in the editing process. However, if you fast forward to the 7:00 mark, the discussion on the symptoms of low estrogen (hot flashes, sexual dysfunction, dry joint ache, and osteoporosis) is listed there. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

@tom jerry: Since DHT is also a metabolite of testosterone, low DHT levels start with testosterone deficiency or a deficiency of another hormone higher in the steroid hormone cascade. Low testosterone or DHT levels can contribute to a depressed mood. However, I would not go as far as to say that these imbalances are solely responsible for severe moderate to severe clinical depression. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@GSD07: Gynecomastia is typically induced in states of excess estrogen influence. As for the differences between low testosterone and low estrogen, it depends on the cause. Low estrogen is typically caused by (in males) a lack of testosterone or perhaps by an overuse of estrogen "blockers" by people on TRT. Isolated symptoms of low estrogen include hot flashes, bone demineralization, mood changes, and sexual dysfunction. For isolated low T, you can see fatigue, decreased libido, erectile dysfunction, poor quality of sleep, irritability, trouble concentrating, and negative changes in body composition. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Testosterone Centers of Texas TY appreciated

​@@TCTmed Just curious if you also ever see hot flashes in patients with high estrogen as well? And if so, do they differ much from the low estrogen hot flashes?? I feel as if when my estrogen is high, I have really bad hot flashes... But when its low I do as well. And what about sleep issues with high estrogen vs low? How do they each affect sleep? Thanks!

@@ColdSun87 Estrogen levels abnormalities or even normal but imbalanced estrogen can cause hot flashes (flushing) AND sleep disturbance on both sides of the spectrum. The character of the flushing doesn't seem to differ significantly, based on what my patients have reported over the years. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Jay Cee: This is different from patient to patient, and I have found that cookie cutter ranges don't work well. That being said, I definitely want to see a normal number here. Some patients feel better with a "low normal" estradiol, and others need it hovering at the upper limits of normal to feel optimized. Rarely do I see patients tolerating levels that are frankly elevated above normal. The point that eliminates high concern for gynecomastia, reduces the need for aromatase inhibitors to a bare minimum, and leaves estrogen levels in the normal range is the target. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Testosterone Centers of Texas thanks doc I have another question for you, I got my total test back at 415and free at 60 would it help running some clomid and nolvadex to see if I naturally come back before going on TRT?

@@diabeticmuscle45: Be leery of any free testosterone reading that is not a calculated free T or equilibrium dialysis. (www.issam.ch/freetesto.htm) Aside from that, using clomiphene and aromatase inhibitors won't jump start natural production, you will still be dependent on the medication to maintain higher levels. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Sir.. I have estrogen rebound problem..how I get rid of high estrogen dominant permanently in men.

sorry to commemt agwin i dont know any oerson or doctor to speak about it

@siuuuuuuuuuu813: The effects of AIs are typically limited to their term of use, and the effects will vary in relation to the half-life of the particular medication. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thanks a lot1😍😍

@m_ax_i!! akerman: Unfortunately, units of measure are not universal so I can't speak to what these results may or may not suggest, and numbers alone don't complete the picture. You really need to be evaluated by a medical professional who can review your history, exam, symptoms, and clinical presentation. That, in conjunction with your lab results will give you the best answer. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Kevin Brown: Physical symptoms and side effects are the most important rate-limiting factors, but a calculated free testosterone level between 9-30 ng/dL is what I consider normal. Normal is not necessarily optimal, so that range for me is more narrow. Converting your reported free T to ng/dL shows you to be at 28.5 ng/dL. So, technically, that is high-normal. However, there is a myriad of issues to consider alongside the numbers. The day of your injection interval, your blood was drawn on, your potential side effects, and your symptomatic improvement, to name a few. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thanks for your reply.. Those numbers were at its lowest point, the morning of my injection. Hardest part for me is not getting stuck on numbers... thanks again

@@kevinbrown1399: You're welcome! I have those conversations often, lol. It's all about symptoms, and the numbers are just our guideposts. That said, if this is a 7-day trough, I find that I often don't need numbers that high to elicit an optimal response. I would encourage you to track "when you feel what". In other words, through the dosing interval, patients tend to feel different strengths vs. side effects. I have found that higher numbers better support anabolic benefits, and that lower (yet still optimized) numbers support androgenic benefits. Both are good and desirable. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed Noted. I lowered my numbers as of my last lab-work (taken monday). Free T 17.6 ng/dl, Total T 548 ng/dl, and still waiting on E2....I only drop things down due to mental sides from the high estrogen. Sensitive to it i guess. I don't like it. I'll return to the higher levels and try to control with an AI and lose a little fat and get off the AI. Its definitely a journey

@@kevinbrown1399 That it is!

@vitor belfort: Typically, low estrogen levels mean that your testosterone levels are relatively low. If you have a considerably low body fat percentage, that could also be a contributing factor. Aside from that, more rarely, hemochromatosis or autoimmune diseases lower estrogen levels in males. The most likely culprit is that your testosterone levels are not adequately supported by the gels you use. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@augiegalindo thnx a lot for answering🙏 my testesterone levels are fine,above middle range. question is what kind of autoimmune disease can cause high estrogen?🙏i dont what to look for,what blood work or which doctor to ask 😢

sorry,low estrogen not high...

@Brian O'Donnell: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Loveng Briian: It is possible. Estradiol levels have a fairly profound effect on fluid balance. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed thank you very much for answering my questions

@@lovengbriian6363 You're most welcome! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@J R: Thank you for the feedback! No, use only serum testing. Both saliva and DUTCH testing show promise, but the narrow sample data used to define reference ranges, when compared to serum, limit their versatility. Bias studies and redundant testing would be needed over a period of time, with a large cohort to move this to the forefront of testing. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Victor Diaz: Thank you for the vote of confidence! We will be moving in that direction soon!! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

While it is possible that your response to clomiphene (Clomid) included an elevation of your prolactin levels, it isn't a certainty. This study (www.ncbi.nlm.nih.gov/pubmed/19359408) showed no changes in prolactin levels measured before and 10 days, 4, 8, and 12 weeks after clomiphene. So, you may have had elevations prior to using clomiphene. If so, a work up would be in order to find the source of the hyperprolactinemia. Non-cancerous pituitary tumors, prolactinomas, could be one cause. Second, tamoxifen does nothing to reduce estrogen levels, only affecting the receptor response. Yes your E2 elevation was secondary to the aromatization of testosterone, but the prolactin elevation was not. I hope this helps. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

You have a high Total T level, but Free T is what exerts its effect on the body. Clomid increases SHBG, which is a function of Total T, therefore increasing the Total T and Free T may still be low. Clomid for men with high SHBG is a fool’s errand.

@Sprawiedliwiator: The way to increase estradiol levels in men is to optimize testosterone levels. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed and without using testosterone how to raise Estradiol?

@@0906mlynek0906, raising estradiol levels in the setting of a testosterone level that is not optimized will have deleterious effects on your androgenic health. Functionally, estrogen opposes testosterone, but moreover, your hypothalamus determines how much stimulation for testosterone production is necessary, in part, by your estradiol levels. So raising estradiol levels not only increases estrogenic influence, but also decreases testosterone production. Recent studies have negated the long held thought that plant based estrogen, or phytoestrogens increases serum estradiol levels, but many people still consider them endocrine disruptors (EDs). Phthalates, BPA, triclosan, teflon, and a myriad of other substances have also been identified as EDs. Ingesting/using these, gaining fat mass, and increasing alcohol consumption are all ways to increase estradiol levels. As you can see, these are healthful options. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed and what should be the right ratio of Testosterone to Estradiol? In my case, according to this calculator www.omnicalculator.com/health/t-e2-ratio 473: 1 is much too much? www.endmemo.com/sconvert/ng_dlng_ml.php

@Yasin Patel: Thank you for your question! I have routinely seen higher or unopposed estrogen levels ("estrogen dominance") influence patients to be more anxious and irritable. While it is often coupled with an underlying predisposition, maintaining normal estradiol levels has successfully managed these symptoms for many patients. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed Many thanks Dr, that answers my question.

@Chris Dopez: Unfortunately, this is just completely different than what we do in TRT. I don't recommend any anabolics like Anavar, or nandrolone. It is always a risky endeavor to make dosing adjustments by "feel" only. I recommend medically managed TRT only. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

If you ever found out how to fix low estrogen please let me know my levels of estrogen producing naturally are too slow its beem ten weeks and i have some emotion and random sex drives bur its nit garanter

@@richardcarrasco4292 estradiol valerate tablet

@@lynxeffect84 would I have to find someone to get this from? Im fine now but I'd like to have some in case this ever happens again

@@richardcarrasco4292 prescribed from endo or trt clinic

@Master Armedforces: Hello, Joe! For transparency's sake I am a PA, not a doc, so Augie works just fine. I agree that your symptoms are very consistent with what we see with low testosterone. Now, while natural production is definitely suppressed when someone takes testosterone, the myth that you will never make your own testosterone again is exactly that, a myth. Keep in mind, however, that if your symptoms are due to a significant decrease in your testosterone production, then what you are fixing is a broken system. If your vision was deteriorating, it would be fantastic if you could use an exercise, device, or medical treatment to retrain your eyes to refract light accurately again. Lasik surgery, and the like, offer a corrective, though somewhat invasive approach that does correct many unwanted changes of the eye at the expense of a costly and somewhat invasive procedure. Sadly, though, our only choice with the failure to produce enough testosterone is more akin to vision correction via the use of external lenses. So, as long as you want to see better, you have to use contacts or glasses. Or, as long as you want to not feel the symptoms of Low T, you have to use TRT once natural means are exhausted. Therefore, in this measure, this is why some people may say that "you have to remain on it for life", but it is NOT because you won't ever produce your own again. Typically, if you've only been on TRT for a short time, you can expect a rebound to you pre-treatment production levels with a few months of stopping TRT. As for estradiol, some supplements like DIM (Diindolylmethane) can help your body metabolize estrogen more efficiently. Additionally, avoiding things like alcohol, phytoestrogen, xenoestrogens, and increase in body fat can help. The following is an excerpt from one of our blog articles, The Importance of Estrogen (Estradiol) in Men’s Health (tctmed.com/estrogen-in-men/). "There are many reasons why your body may be producing too much estrogen. For instance, if you suffer from obesity, your excess fat can actually start producing additional estrogen beyond what your body already produces." Finally, your numbers are incomplete. A total without a calculated free testosterone (issam.ch/freetesto.htm) leaves out the most important part. The Endocrine Society has deemed the analog (direct) free testosterone test to be clinically useless. For your calculated free testosterone you will need your total testosterone, sex hormone binding globulin (SHBG), and your albumin. I hope this helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Augie, could high E2 cause extreme fatigue and muscle soreness? I recently had labs done and the only thing that came back high was E2 at 73. Total test was 864.

@@ericadar3386 Alone, probably not, but what you aren't seeing is with those two numbers is that your SHBG is probably elevated due to the high estradiol, making your calculated free testosterone much lower than you would expect with a total of 864 ng/dL. Therefore, a lower free T matched up with an excessively high E2 can certainly wreak havoc. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed Augie, I see that you have about four clinics in the Ft Worth/Dallas area; I would go to one of them without hesitation if I lived nearby. I have a question about having my blood work being done without fasting. The people at the any lab test now facility here in Sarasota told me that I did not have to be fasting, but I have heard from numerous other people afterwards that I should have been. Is this true?

@@MasterArmedforces Thank you for the affirmation, sir. Yes, you should be fasting. Remember that labs are not run by clinicians, so their recommendations typically only speak to the integrity of the test. It is The Endocrine Society, insurance guidelines, and the physiology of testosterone production that detail why initial testing should be done in the morning, and in a fasting state. The goal is to look at your natural production when it is its highest. Testing before 10 AM, while fasted, is what allows for this. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@gavbrown85: A few things could be at play. The phrase "good test levels" always gives me pause. If you are judging based on your total testosterone levels only, it's easy to be misled. Typically, low estrogen levels are most often seen with an overuse of aromatase inhibitors (if you are taking them), an aromatase deficiency (reasonably rare, could be related to an extremely low body fat percentage), or a relative deficiency in free testosterone. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed I’ve not taken any inibitators I’m all natural I do hav low body fat as I fast and eat clean my normal test levels are at 18.8 but I’ve not had my free testosterone checked

@@TCTmed I tell a lie tho I did think my east was high as to my moods and off balance I was feeling so I took half a tablet easttogen blocker 2 weeks ago may be that could be the cause so I am booked back in.In 4 weeks time for my free test to be checked and my estrogen again so fingers crossed they will all be ok and estrogen back in good range

@@gavbrown164 I recommend taking a look at your calculated free testosterone level.

@@TCTmed hi mate yes I’m going to as I don’t think half a estrogen tablet blocker would make it drop that’s much so I’m in for full hormone bloods in 4 weeks

This can vary from person to person, but generally, staying out of the lower third of the normal range would be desirable. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Michael Trogdon: The most important factor here is side effects, and the most worrisome (and irreversible one) would be gynecomastia. For most labs, an estradiol of 49 pg/mL would be high-normal, or elevated. Measuring at the trough is fine, but monitoring symptoms like nipple sensitivity, fluid retention, breast tissue change, and irritability is very important. So, the short answer is, it depends. You're clinical presentation and labs must be assessed in concert to answer more definitively. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed ok I'm not experiencing any sides. I have been using stinging nettle root to see if it helps, just wondering if a prolactin level of a 33.4 would cause any red flags for your office...

@@michaeltrogdon3469 It also depends. Prolactin levels that are elevated above the normal reference range should be repeated in a fasting state. If still elevated, and especially if above 30, may warrant further investigation. Particularly, there would be concern for the presence of a non-cancerous pituitary tumor. Typically, if present, we we sometimes find a microadenoma/prolactinoma on a brain MRI. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed ok thanks for the responses. They said they would monitor the prolactin levels. Wish I knew about the fasting for my last blood test though...

@@michaeltrogdon3469 You're welcome, we always do this with the initial baseline testing, which should also be done in a fasting state. Make sure to fast before your repeat test. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Gary Simone: This depends on the lab, because each reference laboratory sets their own normal reference range and each manufacturer may have different approaches to running the same assay. For my practice and the 3rd partly lab we use, normal is between 17-60.

@@TCTmed I understand my lab is 16 30. Thus I am at 56 so I am way over per lab

@@garysimone4977 That's definitely concerning.

@Hgg Hkgv: Without the reference range for your particular lab listed I can't be entirely sure, but it appears that you have a high normal E2 level. Your total also looks a smidge high if you are doing daily injections, but TT doesn't always correlate with your free testosterone the way one might think it would. As for penile changes, especially a reduction in size, that is not at all a reaction to TRT that I would classify as common. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Testosterone Centers of Texas thx for your answer .lab range is 10 to 44.do you test your patients with sensitive or regular method?if you do both does eclia tend to show higher résultat than sensitive?

@@hgghkgv4843 We typically use the standard test unless there is a mismatch with symptoms and a lab result that shows the number to be below the lower limit of normal. Honestly, if a man's estradiol is so low that a high-sensitivity test is needed, then there is something wrong. The standard test does seem to read slightly higher than the sensitive. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Testosterone Centers of Texas thx for your answer .i have erectile dis function with this e2 number. As soon as I take a small amount of arimidex érection comes back but arimidex makes me feel really anxious.thats why I think that (in my case)eclia is not correct

@@hgghkgv4843 You can certainly have estrogen excess symptoms with a high-normal estradiol level, and it is entirely possible for a lab error to occur. Your pattern of symptoms seems to suggest that your estrogen level is high for you. Also, consider this: the body's long term reaction to a critically low estradiol level is to balance things out. The body seeks to maintain an even-keel environment called homeostasis. This means that it does what I can to react and achieve balance. If your body is deprived of estrogen for extended periods of time, your body can respond by "up-regulating" your estrogen receptors; increasing your sensitivity to estrogenic influence. So, because of this increased sensitivity, when you do finally have an estrogen level that becomes "low-normal" or even just approaching normal, you can experience symptoms that you would normally only see if your estrogen level were extremely high. It can be a bit of a catch-22, but still, normalizing estradiol levels, and maintaining that normalcy, is very important. On the flip side, you can also experience symptoms one would normally see with elevated estradiol levels, even if they are normal, but approaching the upper limits of normal. Now, anxiety is not a common side effect for anastrozole, but this could be related to your body's own reaction to being "high-normal". I hope that helps! Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

@Andy Yarrington: Hey, Andy! The atrophy seen secondary to TRT is typically reversible, so if you aren't seeing the results you want, make sure to discuss that with your provider. They should be able to adjust your dosing to improve the effectiveness of the hCG therapy! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Uberdriver9: I applaud your success! Diet and activity definitely do impact testosterone production, and if you're lucky, that's all you need to fix. However, that's not the case for millions of patients. Always remember that one person's experience can never characterize all people's genetic, environmental, biological, and personal circumstances. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner